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Recognize Bradycardia

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Bradycardia is defined as a heart rate that is slower than what is considered normal for a child’s age. Bradycardia in children should be evaluated, but not all bradycardia needs to be medically managed. Intervention is required when bradycardia is symptomatic and compromises cardiovascular function. This commonly means that the heart is beating too slowly to maintain blood pressure, thereby causing shock, poor tissue perfusion, and/or a change in mental status. Symptomatic bradycardia may cause a number of signs and symptoms including low blood pressure, pulmonary edema/congestion, abnormal rhythm, chest discomfort, shortness of breath, lightheadedness, and/or confusion or syncope. Bradycardia most commonly becomes symptomatic when it is of new onset for the patient (acute slowing of the heart rate).

Sinus Bradycardia
Normal rhythm with slow rate
First Degree AV Block
PR interval is longer than 0.20 s
Type I Second Degree AV Block (Mobitz I)
PR interval increases in length until QRS complex is dropped
Type II Second Degree AV Block (Mobitz II)
PR interval is the same length with intermittently dropped QRS complex
Third Degree AV Block (Complete)
PR and QRS are not coordinated with each other
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